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By Root 1104 0

’ actions were considered both medically appropriate for the time and even heroic. Under less grave circumstances, the rule of thumb for a single letting session was to keep the vein open until the patient passed out. “Bleeding to syncope,” this was called. In a statement of near Galenic aplomb, the English physician Marshall Hall wrote in 1830: “As long as bloodletting is required, it can be borne; and as long as it can be borne, it is required.” Dr. Hall and his fellow physicians were, of course, a few facts shy of our modern understanding. A healthy person can, in fact, replace a lost pint of blood in about an hour, but it takes weeks for the oxygen-carrying red blood cells to return to normal levels. Thus, frequent and copious lettings served only to create in patients an endless cycle of chronic anemia. These days the amount of blood a phlebotomist withdraws for testing is minor, about half an ounce per vial. And rarely more than seven vials are collected. If a patient does faint, more than likely it’s from a touch of hemophobia, fear of the sight of blood and/or needles.

Rosemary became a licensed phlebotomist in 1965 and thinks of herself as an old-timer in the field. “I started in a little mom-and-pop lab across the hall,” she recalls, gesturing the direction with a tilt of her head. “In those days I’d both take blood and perform basic tests. Everything was done manually—cholesterol levels, blood sugar, enzymes, pregnancy tests.” Wistfulness is just a flash in her eyes. Of course, she explains, the whole field changed virtually overnight with AIDS. Safety procedures tightened. New tests were introduced, others replaced, most now performed with computers at a facility across the Bay. The patients changed, too. For the past fifteen years the majority of Rosemary’s clients have been gay men, like Steve.

“You must have lost a lot of patients,” I say quietly.

Without glancing up from her work, Rosemary considers this. “Oh, gee,” she begins, then changes course. “I’ve gotten to know a lot of patients,” she replies with a smile to Steve.

“Okay, you’re about done for today,” she adds, watching the last vial fill.

Rosemary withdraws the needle while pressing down with a wad of cotton so large it looks like a chunk of pillow. “Hold that, will you?” she tells him. She deposits the butterfly and tubing into a Sharps container, a receptacle for used needles, and then affixes the clump of cotton to the site with half a foot of tape. And that’s that. The whole procedure has taken no more than five minutes. I back out of the cubicle, Steve rises, and, while the three of us small-talk for a moment, I am struck by this tableau: Rosemary stands between us cradling in her hands the vials of his blood. That’s a part of his body, I think; it has passed through his heart. Those five finger-shaped vials must still be warm, like she’s holding his hand in hers. We say goodbye as she gingerly places each one inside a shipping container emblazoned with BIOHAZARD signs.

THREE

Biohazard

PRIOR TO IDL, STEVE HAD REGULARLY HAD HIS BLOOD drawn at a SmithKline Beecham lab near his doctor’s old office. He stopped using this lab in 1994 and we didn’t give it another thought until one day five years ago when I brought in the mail, which included a special-delivery packet from the blood lab.

“Nothing good ever comes by certified mail,” Steve muttered, frowning, as he tore open the manila envelope and pulled out a letter from SmithKline Beecham’s president, dated May 27, 1999. According to the letter, a phlebotomist who’d worked at the lab Steve frequented had reused needles from blood draws (butterfly needles, it turned out). The woman had admitted to doing this “occasionally,” thereby possibly exposing uninfected patients to HIV, hepatitis, and other illnesses. (It was unclear whether her actions were intentionally criminal or inexplicably ignorant, but a year later she would be indicted on multiple felony charges of assault with a deadly weapon—dirty needles.) Records showed that Steve might have been one of her patients, the letter suggested;